CME Review Courses

Title: Comprehensive PANCE Review Book: Follows NCCPA Topic List
Author: Jeremy Boroff PA-C
Format: Paperback / Digital
Deliverables: 300 Board Style Questions & Answers
Purchase Link: Amazon Link

Physician assistants and students preparing for the Physician Assistant National Certifying Examination (PANCE) require streamlined, high-yield study materials that align strictly with the NCCPA Topic List. The Comprehensive PANCE Review Book by Jeremy Boroff PA-C is designed to meet this demand by providing 300 board-style questions that mirror the complexity and content distribution of the actual exam. This resource is engineered for efficiency, allowing candidates to identify knowledge gaps and master clinical concepts without the distractions of extraneous information.

While this book is a primary tool for PANCE preparation, established physician assistants often find it a valuable refresher for maintaining clinical competency. For those moving into the recertification phase, we offer a comprehensive PANRE Review Course that provides 100 hours of AAPA Category 1 CME credit. This course is specifically designed for the PANRE and PANRE-LA, ensuring you remain compliant with NCCPA requirements while gaining practical, clinical knowledge.

Maximizing Your CME Budget

Education is a significant investment. We offer an efficient way to utilize your employer-provided CME funds. Our programs allow the addition of Amazon or Apple Gift Cards ranging from $100 to $1500 to your purchase. This "CME with gift card" model enables you to acquire the necessary educational credits while also obtaining tools to further enrich your professional development.

Our course catalog includes specialized content in:

• Emergency Medicine
• Family Medicine
• Internal Medicine / Hospitalist
• Orthopedics
• Dermatology
• Psychiatry
• Neurology
• Cardiology
• OB/GYN

For those requiring specialized pharmacology credits, our Pharmacology Course provides AAPA Category 1 CME Credit. Note that while our content is written by PAs for PAs, nurse practitioners and physicians also find value in these packages. Physicians should note that our courses count for Category 2 CME credit rather than Category 1.

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Clinical Assessment: Cardiovascular and Pulmonary Systems

The following clinical vignettes represent the style and depth of questions found in the Comprehensive PANCE Review Book and our pa board review course.

Scenario 1

Your patient is a 64-year-old male with a history of hypertension and tobacco use who presents to the emergency department complaining of sudden onset, tearing chest pain that radiates to his back between the scapulae. His blood pressure is 185/110 mmHg in the right arm and 155/95 mmHg in the left arm. A chest X-ray reveals a widened mediastinum.

Which of the following is the most appropriate initial diagnostic study of choice in a hemodynamically stable patient?
A. Transeophageal Echocardiogram (TEE)
B. Computed Tomography Angiography (CTA)
C. Magnetic Resonance Angiography (MRA)
D. Aortography

Explanation:
The correct answer is Computed Tomography Angiography (CTA). In a hemodynamically stable patient with suspected aortic dissection, CTA is the preferred initial diagnostic study due to its high sensitivity, specificity, and rapid availability. It accurately identifies the presence of an intimal flap and the extent of the dissection. A TEE (Choice A) is highly accurate and is the preferred study for patients who are hemodynamically unstable or have renal failure where IV contrast is contraindicated. MRA (Choice C) is highly accurate but time-consuming and often not practical in an acute setting. Aortography (Choice D) was historically the gold standard but has been largely replaced by non-invasive imaging.

Scenario 2

Your patient is a 28-year-old female presenting with a 3-day history of non-productive cough, low-grade fever, and malaise. Physical examination reveals diffuse wheezing and crackles. A chest X-ray shows patchy interstitial infiltrates in the lower lobes. Laboratory results show an elevated cold agglutinin titer.

What is the most likely causative organism?
A. Streptococcus pneumoniae
B. Klebsiella pneumoniae
C. Mycoplasma pneumoniae
D. Legionella pneumophila

Explanation:
The correct answer is Mycoplasma pneumoniae. This is a classic presentation of "walking pneumonia" or atypical pneumonia, which is common in young adults. The presence of interstitial infiltrates on X-ray rather than lobar consolidation, combined with elevated cold agglutinins, is highly suggestive of Mycoplasma. S. pneumoniae (Choice A) typically presents with high fever, productive cough, and lobar consolidation. Klebsiella (Choice B) is more common in alcoholics and presents with "currant jelly" sputum. Legionella (Choice C) often involves gastrointestinal symptoms and hyponatremia.

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Clinical Assessment: Gastrointestinal and Renal Systems

Scenario 3

Your patient is a 45-year-old female who presents with severe right upper quadrant pain that radiates to her right shoulder. She reports the pain began shortly after eating a large meal. On physical exam, there is an arrest of inspiration upon deep palpation of the right upper quadrant.

What is the initial diagnostic study of choice for this condition?
A. Ultrasound of the Right Upper Quadrant
B. Hepatobiliary Iminodiacetic Acid (HIDA) Scan
C. Computed Tomography (CT) of the Abdomen
D. Endoscopic Retrograde Cholangiopancreatography (ERCP)

Explanation:
The correct answer is Ultrasound of the Right Upper Quadrant. The patient’s presentation is consistent with acute cholecystitis (positive Murphy's sign). Ultrasound is the initial test of choice due to its high sensitivity for gallstones, gallbladder wall thickening, and pericholecystic fluid. A HIDA scan (Choice B) is the most sensitive test and is indicated if the ultrasound is inconclusive. CT scans (Choice C) are less sensitive for gallstones but may be used to rule out other pathology. ERCP (Choice D) is a therapeutic and diagnostic tool for choledocholithiasis, not primary cholecystitis.

Scenario 4

Your patient is a 72-year-old male with a history of chronic kidney disease and heart failure who presents with generalized weakness and palpitations. An EKG is performed and shows peaked T waves, a widened QRS complex, and a prolonged PR interval.

Which of the following is the most appropriate immediate step in the management of this patient?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium Gluconate
C. Intravenous Insulin and Glucose
D. Hemodialysis

Explanation:
The correct answer is Calcium Gluconate. The EKG findings are pathognomonic for severe hyperkalemia. Calcium gluconate (or calcium chloride) is the immediate priority to stabilize the cardiac membrane and prevent life-threatening arrhythmias. It does not lower the potassium level but provides cardioprotection. Insulin and glucose (Choice C) or inhaled albuterol are used to shift potassium into the cells. Kayexalate (Choice A) and hemodialysis (Choice D) are used to remove potassium from the body, but they do not act fast enough to address immediate cardiac instability.

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Clinical Assessment: Behavioral Health and Endocrinology

Scenario 5

Your patient is a 24-year-old male brought to the clinic by his family because of a 1-month history of decreased sleep, rapid speech, and excessive spending. He recently quit his job, claiming he has developed a "secret formula for infinite wealth" and has been seen dancing on top of his car at 3:00 AM. He has no prior psychiatric history.

What is the most likely diagnosis?
A. Major Depressive Disorder with Psychotic Features
B. Schizoaffective Disorder
C. Bipolar I Disorder
D. Cyclothymic Disorder

Explanation:
The correct answer is Bipolar I Disorder. The patient is experiencing a manic episode, characterized by grandiosity, decreased need for sleep, pressured speech, and impulsive behavior (spending). A single manic episode is sufficient for the diagnosis of Bipolar I Disorder. Schizoaffective disorder (Choice B) requires a period of at least two weeks of delusions or hallucinations in the absence of a major mood episode. Cyclothymic disorder (Choice D) involves milder swings (hypomania and mild depression) over at least two years.

Scenario 6

Your patient is a 52-year-old female with Type 2 Diabetes Mellitus who presents for a routine follow-up. Her hemoglobin A1c is 8.4% despite adherence to metformin at maximum dose. She has a history of atherosclerotic cardiovascular disease (ASCVD).

Which of the following classes of medication should be added next to her regimen?
A. Sulfonylurea
B. GLP-1 Receptor Agonist
C. DPP-4 Inhibitor
D. Thiazolidinedione

Explanation:
The correct answer is GLP-1 Receptor Agonist. Current clinical guidelines recommend the addition of a GLP-1 receptor agonist or an SGLT2 inhibitor in patients with Type 2 Diabetes and established ASCVD, regardless of A1c levels, due to their proven cardiovascular benefits. Sulfonylureas (Choice A) increase the risk of hypoglycemia and weight gain without providing cardiovascular protection. DPP-4 inhibitors (Choice C) and Thiazolidinediones (Choice D) are generally considered later-line or in specific patient populations without the same level of ASCVD benefit.

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Strategic Study for PANCE Success

Utilizing resources that strictly follow the NCCPA Topic List is the most effective way to prepare for the PANCE and PANRE exams. The Comprehensive PANCE Review Book provides the necessary volume of practice questions to build clinical stamina and diagnostic accuracy.

As you progress through your career, remember that CME Review Courses is your partner in maintaining professional excellence. Whether you need the 100 hours of AAPA Category 1 credit from our PANRE Review Course or specific pharmacology credits, we provide high-quality content developed by physician assistants.

Enhance your education today and maximize your CME funds by selecting a package with an Amazon or Apple Gift Card add-on.

Explore our courses:

• CME with Gift Card Packages
• PANRE Review Course
• Pharmacology CME

Invest in your clinical knowledge and your career with tools designed for the modern medical professional.

Price: Starting at $499 (Depending on Gift Card Add-On)
Duration of Access: 1 Year of Unlimited Access
Deliverables: Comprehensive Video Modules, Practice Question Bank, and AAPA Category 1 CME Credit

Staying current with the rapidly evolving landscape of obesity pharmacology is no longer optional for the modern clinician. Whether you are prepping for your PANRE or managing a high-volume primary care panel, understanding the nuances of GLP-1 receptor agonists and GIP/GLP-1 dual agonists is critical for 2026 practice.

Our Pharmacology Course provides a deep dive into these agents, offering AAPA Category 1 CME Credit. This course was written by PAs specifically for PAs, though nurse practitioners and physicians also find immense value in the clinically focused content. For those nearing their recertification cycle, our PANRE Review Course offers a full 100 hours of AAPA Category 1 Credit, making it the most efficient way to meet your requirements.

We also offer an efficient way to maximize your CME budget. Our CME with Gift Card packages allow you to add an Amazon or Apple Gift Card (ranging from $100 to $1500) to your purchase. This allows you to further enrich your professional education while receiving a "clean" receipt for reimbursement.

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The Current State of GLP-1 Pharmacology

Obesity management has shifted from a "lifestyle-first" paradigm to a "biologically-driven" approach. As of April 2026, the FDA-approved roster for chronic weight management includes several key agents that every PA must master.

Mechanism of Action: Beyond Appetite Suppression

Glucagon-like peptide-1 (GLP-1) and Glucose-dependent insulinotropic peptide (GIP) are incretin hormones. While GLP-1 primarily slows gastric emptying and increases postprandial satiety via the hypothalamus, GIP adds a layer of metabolic regulation, specifically improving insulin sensitivity and potentially reducing the nausea associated with GLP-1 monotherapy.

High-Yield Agent Profiles for 2026

1. Wegovy (semaglutide 2.4 mg): The established injectable standard. In the STEP 1 trials, it demonstrated roughly 15% weight loss over 68 weeks.
2. Wegovy Oral (semaglutide 25 mg): Approved in late 2025, this daily tablet offers a non-injectable alternative for patients with needle phobia, though it requires strict fasting and water restrictions for absorption.
3. Zepbound (tirzepatide): A dual GIP/GLP-1 agonist. Clinical data (SURMOUNT-5) shows superiority over semaglutide monotherapy, with weight loss reaching 20-22% over 72 weeks.
4. Foundayo (orforglipron): The newest addition to the 2026 toolkit. As a non-peptide, small-molecule oral GLP-1, it does not require the strict fasting conditions of oral semaglutide, allowing for much higher patient adherence.

Clinical Application and Eligibility

When evaluating a patient for these therapies, use the standard BMI benchmarks. A patient is eligible for pharmacological intervention if their BMI is ≥30 kg/m² or ≥27 kg/m² with at least one weight-related comorbidity such as hypertension, T2DM, or dyslipidemia.

PAs should monitor for common side effects: nausea, vomiting, and diarrhea: which are usually transient during the dose-escalation phase. More serious but rare risks include pancreatitis and biliary disease.

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Clinical Vignette: Practical Assessment

Your patient is a 44-year-old male presenting for a follow-up on his obesity management. He has a BMI of 34 kg/m² and a history of hypertension. He has been on Wegovy (semaglutide 2.4 mg) for six months but reports "plateauing" and is frustrated by the weekly injections. He asks about "the new dual-action shot" he heard about. His labs are unremarkable, and he has no history of medullary thyroid carcinoma or MEN 2.

Which of the following is the most appropriate pharmacological transition for this patient?

A) Transition to Wegovy Oral 25 mg daily
B) Transition to Zepbound (tirzepatide)
C) Add phentermine 15 mg daily to the current regimen
D) Discontinue semaglutide and start Foundayo (orforglipron)

Explanation:
The correct answer is B. Zepbound (tirzepatide) is a dual GLP-1/GIP receptor agonist that has shown superior weight loss efficacy compared to semaglutide monotherapy in head-to-head trials (SURMOUNT-5). It remains a weekly injection, but its dual mechanism addresses the patient's plateau more effectively than switching to an oral version of the same drug (Option A). While adding phentermine (Option C) is a possibility, the dual-agonist profile of tirzepatide is the next logical step in high-yield obesity management for patients failing monotherapy. Foundayo (Option D) is an oral option, but the patient specifically asked about the "dual-action shot."

Practice Questions

Question 1:
A 52-year-old female with a BMI of 31 kg/m² and controlled Type 2 Diabetes is interested in the new oral medication Foundayo (orforglipron). What is the primary pharmacological advantage of this agent over Wegovy Oral (semaglutide)?

A) It is a dual GLP-1/GIP agonist.
B) It has a higher percentage of weight loss than injectable tirzepatide.
C) It is a small-molecule non-peptide that does not require strict fasting for absorption.
D) It is administered once monthly rather than once daily.

Explanation:
The correct answer is C. Foundayo (orforglipron) is a small-molecule GLP-1 receptor agonist. Unlike oral semaglutide, which is a peptide requiring a large dose and specific fasting conditions to be absorbed, small molecules like orforglipron can be taken with or without food. Option A is incorrect as it is a monotherapy. Option B is incorrect; injectable tirzepatide still holds the lead in weight loss percentage. Option D is incorrect; it is a daily oral medication.

Question 2:
Which of the following is a contraindication for the initiation of GLP-1 receptor agonists in a patient with a BMI of 35 kg/m²?

A) Personal or family history of Medullary Thyroid Carcinoma (MTC).
B) History of Cholelithiasis.
C) BMI between 27 and 30 kg/m².
D) History of Gastroesophageal Reflux Disease (GERD).

Explanation:
The correct answer is A. A personal or family history of Medullary Thyroid Carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) is a boxed warning and absolute contraindication for GLP-1 and dual agonists due to risks identified in rodent studies. While cholelithiasis (Option B) and GERD (Option D) require cautious monitoring as these drugs can exacerbate these conditions via delayed gastric emptying, they are not absolute contraindications. Option C describes the eligibility range for patients with comorbidities.

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Maximize your 2026 CME experience by choosing a program that respects your time and your budget. Visit CME Review Courses today to explore our PANRE Review and Pharmacology packages. Don't forget to take advantage of our CME with Gift Card options to get the most out of your employer-provided CME funds.

Choosing a board review course is one of the most critical professional decisions a Physician Assistant (PA) makes every few years. Whether you are preparing for the traditional PANRE or participating in the PANRE-LA, the sheer volume of medical knowledge required to satisfy the NCCPA Blueprint can be overwhelming. Not all courses are created equal, and many fail to respect the limited time and specific needs of a practicing clinician.

At CME Review Courses, we understand that your time is valuable and your CME budget should work for you. Our content is written by PAs for PAs, ensuring that the clinical complexity and high-yield focus match the reality of the profession.

Before you invest your time and money, here are 10 things you should know about selecting the right board review course.

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1. NCCPA Blueprint Alignment is Mandatory

The first and most important criterion for any board review course is its alignment with the NCCPA Blueprint. The NCCPA periodically updates the exam content, shifting percentages across organ systems. A course that relies on outdated materials from three years ago will leave you over-prepared for rare conditions and under-prepared for the core content categories like Cardiology (13%), Pulmonary (10%), and GI (9%). Ensure your course covers all 15 official content categories in the correct proportions.

2. Credit Types Matter: AAPA Category 1

Not all CME credits are created equal for the PA-C. While many courses offer AMA PRA Category 1 Credit™, PAs should prioritize AAPA Category 1 Credit. This is the gold standard for our profession. Our PANRE Review Course provides 100 hours of AAPA Category 1 credit, which is specifically designed to fulfill your major credit requirements in one efficient package. If you are a Nurse Practitioner, keep in mind that the acceptance of AAPA credits varies from state to state, so always verify with your state board.

3. Maximize Your CME Budget with Gift Card Add-ons

Most employers provide a dedicated CME allowance, but many PAs struggle to spend the entire amount or find it difficult to justify high costs for materials that expire. An efficient way to use your CME money is to select a course that offers Amazon or Apple Gift Card add-ons. This allows you to add a $100 to $1,500 gift card to your purchase, which can be used to further enrich your education by purchasing medical equipment, reference books, or technology.

4. Content Written by PAs for PAs

There is a distinct difference between board review content written by academic physicians and content written by practicing PAs. PAs understand the nuances of the "Physician Assistant" perspective, focusing on the diagnostic and management steps most likely to appear on the exam. Our courses are developed by Jeremy Boroff, PA-C, ensuring the content is peer-relevant and practical.

5. Demand Flexible Formats

Avoid courses that force you into a rigid subscription model or require multiple logins that expire after 90 days. As a working professional, you need a course that you can own. Our review exams are available in formats that allow you to own the content permanently, with no expiration and no recurring fees. This is particularly useful for the PANRE-LA, where you may need to reference specific organ system reviews over a three-year period.

6. Retrieval Practice Over Passive Reading

Passive reading of textbooks is the least effective way to retain medical information. The most effective method is retrieval practice. When choosing a course, look for a "forced recall" design. For example, our practice exams reveal the correct answer only after the choices, forcing you to commit to an answer before checking. This simulates the high-stakes environment of the actual testing center.

7. Organ System Specificity

A generic review is often not enough. If you work in a specialty like Orthopedics or Dermatology, you may feel rusty in Cardiology or OB/GYN. Your review course should allow you to dive deep into specific domains. We offer comprehensive content across:

• Emergency Medicine
• Family Medicine
• Internal Medicine/Hospitalist
• Orthopedics
• Dermatology
• Psychiatry
• Neurology
• Cardiology
• OB/GYN

8. Clinical Vignette Complexity

The PANRE has moved away from "first-order" questions (simple recall) and toward complex clinical vignettes. A high-quality course will provide vignettes that include patient demographics, vitals, and physical exam findings, requiring you to make a multi-step diagnostic or management decision.

9. Pharmacology Credit Requirements

Many states and hospital systems now require specific pharmacology CME hours. It is highly efficient to choose a provider that offers both a general PANRE review and a dedicated Pharmacology Course. Our Pharmacology Course also carries AAPA Category 1 Credit, making it easy to satisfy those specific requirements while preparing for boards.

10. Cost-Effectiveness and Deliverables

Before purchasing, look for clear, bolded logistics. You should know exactly what you are getting, for how much, and how long you will have access to it.

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Course Spotlight: 100-Hour PANRE Review Course

• Price: $399.99 (Base course, plus gift card add-on options)
• Deliverable: 100 Hours of AAPA Category 1 Credit
• Access: No subscription, no expiration, no login required for the book/exam series.
• Content: Aligned to the NCCPA Blueprint, covering all 15 organ systems.

View the PANRE Review Course Options Here

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Clinical Assessment: Case Study

Your patient is a 64-year-old male with a history of hypertension and tobacco use who presents to the emergency department with sudden onset of severe, tearing chest pain that radiates to his back. His blood pressure in the right arm is 190/110 mmHg, and in the left arm, it is 160/95 mmHg. His heart rate is 105 bpm. A chest X-ray reveals a widened mediastinum.

Which of the following is the most appropriate initial pharmacological management for this patient?

A. Intravenous Nitroprusside
B. Intravenous Esmolol
C. Intravenous Hydralazine
D. Oral Amlodipine
E. Intravenous Heparin

Explanation:
The correct answer is B. Intravenous Esmolol.

The patient’s presentation is classic for an acute aortic dissection (tearing pain, blood pressure discrepancy, widened mediastinum). The primary goal in the management of aortic dissection is "anti-impulse therapy" to reduce the shear stress on the aortic wall. This requires lowering both the heart rate and the blood pressure.

Esmolol (or another IV beta-blocker like Labetalol) is the first-line treatment because it reduces the heart rate (target < 60 bpm) and the contractility of the heart (dP/dt). Only after the heart rate is controlled should vasodilators like Nitroprusside (A) be added, as vasodilators can cause reflex tachycardia, which increases the shear stress on the dissection and may propagate the tear. Hydralazine (C) is contraindicated for the same reason: it can cause reflex tachycardia. Amlodipine (D) is an oral medication and is inappropriate for an acute hypertensive emergency. Heparin (E) is contraindicated in suspected or confirmed aortic dissection as it can worsen the hemorrhage.

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Why Choose CME Review Courses?

Preparation for the PANRE should not be a months-long marathon through 2,000 irrelevant questions. It should be a focused, high-yield review of the topics the NCCPA actually tests. By choosing a course written by PAs, you ensure that you are studying the right material in the most efficient way possible.

Whether you are looking for the full 100-hour PANRE Review Course or looking to bolster your knowledge in a specific area like Internal Medicine or Emergency Medicine, we provide the tools you need to pass your exams and improve your clinical practice.

Efficient CME for Busy Professionals

We also cater to Internal Medicine Physicians who find value in our clinical content. While our courses count as Category 1 AAPA Credit for PAs, physicians can often claim them as Category 2 CME. This makes our packages a versatile option for the entire clinical team.

Stop overpaying for subscriptions you don't use. Invest in a review course that respects your profession and your wallet.

Explore our full catalog of CME with Gift Card options at CMEReviewCourses.com.

Price: $9.99
Access: Permanent (No subscription, no login)
Deliverables: 240 full-length practice questions with detailed explanations

Preparing for the PANRE or PANRE-LA requires a shift from passive reading to active clinical reasoning. Most question banks encourage "answer-peeking" by placing the correct answer directly under the question or allowing a "show answer" button that is too easily clicked before the clinician has fully committed to a diagnostic or management path.

The PANRE/PANRE-LA Review Exam 1 eBook is designed specifically to disrupt this passive habit. By revealing the correct answer and the detailed explanations only after the five multiple-choice options, it forces a cognitive commitment. This method: known as retrieval practice: is the most effective way to identify knowledge gaps and ensure long-term retention of high-yield clinical facts.

High-Yield Content for the Working PA-C

This digital review is not a 2,000-question repository that takes months to navigate. It is a focused, high-yield tool for the working PA-C who needs to maximize study efficiency. Each question is written at the clinical complexity expected on the NCCPA Blueprint.

The eBook format provides portability, allowing you to review organ systems during a break in the clinic, between cases in the OR, or on a mobile device while commuting. Because there is no login or subscription required, you own the content permanently. This is especially valuable for those taking the PANRE-LA, where questions are spread over several years and a reliable, easy-access reference is required.

2025 NCCPA Blueprint Alignment

The exam is precisely weighted to reflect the NCCPA 2025 Content Blueprint. To pass the PANRE, you must master the proportions of the exam as much as the content itself. This exam distributes 240 questions across the 15 official categories to ensure you are spending the correct amount of time on high-stakes systems like Cardiovascular and Pulmonary medicine.

The question distribution for Exam 1 is as follows:

• Cardiovascular: 26 questions
• Pulmonary: 22 questions
• Gastrointestinal/Nutrition: 19 questions
• Musculoskeletal: 19 questions
• Infectious Diseases: 17 questions
• Neurology: 17 questions
• Psychiatry/Behavioral Science: 17 questions
• Reproductive: 17 questions
• Endocrine: 14 questions
• EENT: 14 questions
• Professional Practice: 14 questions
• Hematology: 12 questions
• Renal: 12 questions
• Dermatology: 10 questions
• Genitourinary: 10 questions

Clinical Vignette Assessment

Effective board preparation mimics the real-world clinical environment. Below are sample questions from the exam bank to demonstrate the required level of clinical reasoning.

Case 1: Cardiology

Your patient is a 68-year-old male presenting with a 3-day history of progressive dyspnea on exertion and a non-productive cough. He has a history of hypertension and a myocardial infarction four years ago. Physical exam reveals a HR of 105 bpm, BP of 155/92 mmHg, and SaO2 of 93% on room air. You note bilateral 2+ pitting edema and crackles in the lower lung fields. An S3 gallop is heard on auscultation.

Which of the following is the most appropriate initial diagnostic test to confirm the suspected diagnosis?

A. Chest X-ray
B. B-type natriuretic peptide (BNP)
C. Echocardiogram
D. 12-lead ECG
E. Cardiac Catheterization

Correct Answer: C. Echocardiogram

Explanation: The patient presents with classic signs and symptoms of congestive heart failure (CHF), likely an exacerbation of chronic heart failure. An echocardiogram is the definitive initial diagnostic test to assess left ventricular ejection fraction (LVEF) and differentiate between heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).

• A. Chest X-ray is helpful for identifying pulmonary edema (Kerley B lines) but does not provide functional data on the heart.
• B. BNP is useful in the ED to differentiate dyspnea caused by CHF from pulmonary causes but does not confirm the underlying cardiac structure or function as well as an echo.
• D. 12-lead ECG may show signs of prior MI or LV hypertrophy but is not confirmatory for CHF diagnosis.
• E. Cardiac Catheterization is an invasive procedure used to assess coronary artery disease or hemodynamics but is not the first-line diagnostic test for CHF.

Case 2: Infectious Disease

Your patient is a 24-year-old female presenting with a 2-day history of dysuria, frequency, and suprapubic pain. She denies fever, chills, or flank pain. Vital signs are HR 78 bpm, BP 120/80 mmHg, and Temp 98.6°F. Urinalysis shows positive nitrites and leukocyte esterase.

Which of the following is the first-line treatment for this patient, assuming no known allergies and low local resistance patterns?

A. Ciprofloxacin
B. Nitrofurantoin
C. Cephalexin
D. Azithromycin
E. Doxycycline

Correct Answer: B. Nitrofurantoin

Explanation: The patient has an uncomplicated urinary tract infection (UTI). Nitrofurantoin (Macrobid) 100 mg BID for 5 days is a first-line treatment recommended by current guidelines due to its efficacy and minimal impact on vaginal flora.

• A. Ciprofloxacin is effective but no longer recommended as first-line for uncomplicated UTIs due to concerns regarding side effects (tendon rupture) and increasing resistance.
• C. Cephalexin is an alternative but is typically reserved for cases where first-line agents cannot be used.
• D. Azithromycin and E. Doxycycline are used for urethritis (e.g., Chlamydia) but are not appropriate for bacterial cystitis.

Professional Practice and Ethics

A unique feature of the PANRE Review Exam is the inclusion of the Professional Practice category (14 questions). This section covers the "Legal and Ethical" portion of the NCCPA Blueprint, including topics such as:

• Informed consent
• Patient confidentiality (HIPAA)
• Medical errors and safety
• Physician-PA relationship
• End-of-life care and advanced directives

Understanding these concepts is critical for the 14 questions you will encounter on the 240-question exam.

Maximize Your CME Allowance

For many PA-Cs, the cost of board prep is covered by a yearly CME allowance. At cmereviewcourses.com, we offer advanced packages that allow you to bundle your learning with added value.

Our CME with Gift Card options are a popular way to utilize remaining CME funds. You can purchase a high-yield review course: such as the PANRE Review Course (which offers 100 hours of Category 1 AAPA Credit) or our Pharmacology Course: and add an Amazon or Apple gift card ($100 to $1,500) to your purchase. This allows you to purchase medical equipment, additional textbooks, or technology to further your professional development.

While physicians and nurse practitioners frequently find value in our content, it is important to note:

• The 100 hours of Category 1 AAPA Credit applies specifically to the PANRE Review Course on our website.
• Physicians can claim these credits as Category 2 CME.
• Nurse practitioners may claim Category 1 AAPA Credit in many states, though requirements vary by state board.

Start Your Review Today

Exam 1 is the first of a 3-exam series totaling 720 questions. You can choose to master one exam at a time or bundle them for a comprehensive review.

The eBook version offers the most cost-effective and portable way to begin your retrieval practice.

Buy PANRE/PANRE-LA Review Exam 1 on Amazon

For those seeking the full 100-hour Category 1 AAPA Credit experience with additional video content over Emergency Medicine, Family Medicine, Orthopedics, Cardiology, and more, visit our PANCE/PANRE Blueprint Review Course page.

Prepare with content written by physician assistants, for physician assistants. Stop passive studying and start committing to your clinical answers.

Product: PANRE Review Exam 1
Deliverables: 240-question practice examination with comprehensive explanations
Format: Ebook/Print via Amazon or Digital via CME Review Courses
Access: Permanent ownership; no subscription or login required
CME Credit: 100 hours of AAPA Category 1 Credit available through the full PANRE Review Course

Preparing for the Physician Assistant National Recertification Exam (PANRE) or the PANRE-LA requires a shift from passive reading to active clinical reasoning. Most question banks encourage "answer-peeking" by displaying the correct choice immediately, which bypasses the cognitive effort required for long-term retention. PANRE Review Exam 1 is engineered to eliminate this habit. It provides a full-length, 240-question mock exam designed to mirror the actual testing environment of the NCCPA.

This resource is written by physician assistants for physician assistants. It prioritizes high-yield clinical facts and evidence-based medicine over esoteric details. Whether you are a seasoned PA-C or nearing your first recertification cycle, this exam provides the diagnostic and management scenarios you will encounter on test day.

The Active Recall Advantage

Passive study methods, such as highlighting text or rereading notes, offer a false sense of mastery. Real mastery is built through retrieval practice. The format of this exam forces you to commit to an answer before the correct choice and explanation are revealed.

Each question follows a 5-answer multiple-choice format, consistent with the NCCPA standard. By committing to an answer before checking the key, you engage the neural pathways responsible for recall. When a mistake is made, the subsequent correction is more likely to be retained. This "forced recall" method is particularly effective for the longitudinal assessment format (PANRE-LA), where speed and accuracy are paramount across various clinical systems.

Precise NCCPA Blueprint Alignment

Success on the PANRE depends on studying the right topics in the right proportions. PANRE Review Exam 1 is mapped directly to the NCCPA Blueprint categories. You will not find a skewed distribution of questions; instead, the 240 items are allocated based on the weight of each organ system as defined for the 2025 exam cycle.

The question distribution for Exam 1 is as follows:

• Cardiovascular: 26 questions
• Pulmonary: 22 questions
• Gastrointestinal/Nutrition: 19 questions
• Musculoskeletal: 19 questions
• Infectious Diseases: 17 questions
• Neurology: 17 questions
• Psychiatry/Behavioral Science: 17 questions
• Reproductive: 17 questions
• Endocrine: 14 questions
• EENT: 14 questions
• Professional Practice: 14 questions
• Hematology: 12 questions
• Renal: 12 questions
• Dermatology: 10 questions
• Genitourinary: 10 questions

This is Exam 1 of a 3-exam series. Utilizing all three exams provides a total of 720 blueprint-aligned questions, offering comprehensive coverage of all 15 organ systems.

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Physician assistants often have fixed annual CME allowances. We provide an efficient way to utilize these funds. Through cmereviewcourses.com, you can purchase CME packages that include Amazon or Apple gift card add-ons ranging from $100 to $1500. This allows you to secure high-yield educational materials while simultaneously acquiring the tools: such as tablets, medical equipment, or reference books: needed to further your clinical practice.

While our content is highly valued by nurse practitioners and physicians, note that AAPA Category 1 Credit for nurse practitioners is subject to state-specific regulations. For physicians, this content typically qualifies for Category 2 CME credit.

Clinical Assessment Practice Questions

The following scenarios represent the level of clinical complexity found in PANRE Review Exam 1. Use these to test your current knowledge.

Question 1

Your patient is a 54-year-old male with a history of hypertension and tobacco use who presents to the clinic with complaints of progressive exertional dyspnea and a non-productive cough. Physical examination reveals fine bibasilar inspiratory crackles and clubbing of the fingers. High-resolution CT (HRCT) of the chest demonstrates subpleural reticular opacities and honeycombing, primarily in the lower lobes. Pulmonary function testing (PFT) shows a restrictive pattern with a reduced DLCO. What is the most likely diagnosis?

A) Sarcoidosis
B) Idiopathic Pulmonary Fibrosis (IPF)
C) Hypersensitivity Pneumonitis
D) Asbestosis
E) Congestive Heart Failure

Correct Answer: B) Idiopathic Pulmonary Fibrosis (IPF)
IPF is the correct diagnosis based on the clinical presentation of progressive dyspnea, finger clubbing, and the classic HRCT finding of "honeycombing" and subpleural reticulation in the lower lobes. PFTs in IPF typically show a restrictive pattern (decreased FVC, normal FEV1/FVC ratio) and a decreased DLCO. Sarcoidosis usually presents with hilar lymphadenopathy and non-caseating granulomas. Hypersensitivity Pneumonitis typically involves an identifiable environmental exposure and centrilobular nodules on CT. Asbestosis would require a significant occupational history and often shows pleural plaques. Congestive Heart Failure would present with cardiomegaly, Kerley B lines, and symptoms like orthopnea.

Question 2

Your patient is a 29-year-old female, G1P0 at 34 weeks gestation, who presents to the labor and delivery unit with a headache, blurry vision, and epigastric pain. Her blood pressure is 164/112 mmHg. Urinalysis shows 3+ proteinuria. AST and ALT are twice the upper limit of normal, and her platelet count is 88,000/µL. Which of the following is the most appropriate next step in management?

A) Outpatient monitoring with weekly NSTs
B) Immediate delivery via Cesarean section
C) Administration of Magnesium Sulfate and preparation for delivery
D) Oral Labetalol and discharge home with follow-up in 24 hours
E) Bed rest and repeat labs in 48 hours

Correct Answer: C) Administration of Magnesium Sulfate and preparation for delivery
The correct management is Magnesium Sulfate for seizure prophylaxis and proceeding toward delivery. This patient meets the criteria for Preeclampsia with Severe Features (BP >160/110, headache, visual changes, epigastric pain, and thrombocytopenia). At 34 weeks, the definitive treatment for severe preeclampsia is delivery. Outpatient monitoring or bed rest is contraindicated in severe preeclampsia due to the risk of maternal and fetal morbidity. Immediate Cesarean is not necessarily required; induction of labor is often preferred unless there are other obstetric indications for surgery. Oral Labetalol alone is insufficient and discharging the patient is dangerous.

Question 3

Your patient is a 62-year-old male presenting with sudden onset of severe "tearing" chest pain that radiates to the back between the scapulae. On examination, he is diaphoretic with a blood pressure of 185/105 mmHg in the right arm and 155/90 mmHg in the left arm. A chest X-ray shows a widened mediastinum. What is the most appropriate initial diagnostic test?

A) Transthoracic Echocardiogram (TTE)
B) CT Angiography (CTA) of the chest and abdomen
C) Exercise Stress Test
D) Cardiac Catheterization
E) D-dimer assay

Correct Answer: B) CT Angiography (CTA) of the chest and abdomen
CT Angiography is the preferred initial diagnostic test for suspected aortic dissection in a hemodynamically stable patient due to its high sensitivity and ability to delineate the extent of the dissection. The presentation of "tearing" pain and a blood pressure discrepancy between arms is classic for aortic dissection. TTE is often insufficient to visualize the descending aorta; a Transesophageal Echocardiogram (TEE) would be more sensitive but is more invasive. Stress testing is contraindicated in acute chest pain of this nature. Cardiac Catheterization might be used to evaluate coronaries but is not the initial test for dissection. D-dimer is non-specific and should not delay imaging when clinical suspicion is high.

Preparation Summary

The journey to recertification does not have to be an overwhelming process of trial and error. By utilizing a blueprint-aligned, active recall-based practice exam, you can identify knowledge gaps and refine your clinical reasoning before the stakes are high.

PANRE Review Exam 1 is available for purchase today. You can find the printed or ebook version directly on Amazon. For those looking to maximize their CME allowance with gift card add-ons, visit CME Review Courses to explore our full suite of PANRE and Pharmacology review options.

Invest in your education effectively. Commit to the answer, master the blueprint, and secure your recertification.

Price: $9.99
Format: Paperback / eBook
Content: 100% PAEA Blueprint Aligned
Deliverables: 14 Clinical System Reviews + 120-Question Practice Exam

The Family Medicine End of Rotation (EOR) exam is the broadest assessment in the physician assistant clinical year. Unlike specialty rotations where the scope is narrow, family medicine requires proficiency across the entire lifespan, from pediatric developmental milestones to geriatric end-of-life care. To pass with a high score, you must move beyond passive reading and focus on high-yield clinical presentations, initial diagnostic workups, and first-line treatment protocols.

Direct Alignment with the 2026 PAEA Blueprint

Success on the EOR requires studying specifically for what is tested. The Family Medicine End of Rotation Review: High-Yield Prep for Physician Assistants is built around the official PAEA topic list. This guide eliminates the noise of traditional textbooks and focuses on the high-probability topics that will actually appear on your 120-question exam.

The exam is weighted heavily toward three key areas:

• Cardiovascular Disorders (15%)
• Pulmonology Disorders (12%)
• Gastrointestinal & Nutritional Disorders (11%)

Mastering these three systems alone accounts for nearly 40% of your total score. Our guide prioritizes these high-yield systems while providing comprehensive coverage of the remaining 11 categories, including EENT, OB/GYN, Orthopedics, and Psychiatry.

Strategic Content Breakdown

Clinical rotations are fast-paced, and your study time is limited. Each chapter in this review book is written in a functional, declarative style. We emphasize pathophysiology only where it clarifies the "why" behind the clinical presentation.

Cardiovascular Pearls: Focus on the differentiation of murmurs, the management of hypertension according to current JNC and ACC/AHA guidelines, and the initial workup of stable vs. unstable angina in an outpatient setting.

Pulmonology High-Yields: You must be able to distinguish between obstructive and restrictive lung diseases on PFTs. Expect questions on the stepwise management of asthma and the appropriate antibiotic selection for community-acquired pneumonia (CAP) based on comorbidities.

Gastrointestinal Focus: The exam frequently tests the PALM-COEIN classification for abnormal uterine bleeding and the management of common primary care complaints like GERD, PUD, and biliary disease.

Master the 120-Question Practice Exam

The best way to prepare for a 120-question exam is to take a 120-question exam. At the conclusion of this book, you will find a full-length practice bank designed to simulate the real exam environment.

Each clinical vignette is crafted to mirror the difficulty level of the PAEA exam. We provide five answer choices for every item and detailed explanations that explain why the correct answer is the gold standard and why the distractors are incorrect. This active recall method is the most efficient way to identify and correct your knowledge gaps before test day.

Maximize Your CME Efficiency

While students focus on passing the EOR, practicing PAs must focus on maintaining certification. CME Review Courses offers an efficient way to use your CME money through our PANRE Review Course, which provides 100 hours of Category 1 AAPA Credit.

For those looking to enrich their education further, we offer CME with Amazon and Apple Gift Card add-ons. These packages allow you to add a gift card ranging from $100 to $1500 to your CME purchase, providing a streamlined way to acquire the medical resources or technology you need for your practice.

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Clinical Assessment: Practice Questions

Question 1

Your patient is a 64-year-old male presenting with a 3-month history of exertional chest pain that is relieved by rest. He has a history of hypertension and tobacco use. His HR is 82, BP is 138/88 mmHg, and SaO2 is 98% on room air. An EKG performed in the office is normal. What is the most appropriate initial diagnostic test to evaluate for coronary artery disease in this patient?

A. Cardiac Catheterization
B. Exercise Stress Test
C. Coronary CT Angiography
D. Resting Echocardiogram
E. Pharmacologic Stress Test

Correct Answer: B. Exercise Stress Test
Explanation: In a patient with stable angina symptoms and a normal baseline EKG, the Exercise Stress Test is the appropriate initial non-invasive choice to evaluate for ischemia. It is cost-effective and provides functional data regarding the patient's exercise capacity. Cardiac Catheterization (A) is the gold standard but is invasive and reserved for patients with high-risk findings or refractory symptoms. Coronary CT Angiography (C) is useful for ruling out CAD in low-to-intermediate risk patients but is not the standard first-line functional test here. Resting Echocardiogram (D) evaluates wall motion and valves but does not assess for inducible ischemia. Pharmacologic Stress Test (E) is only indicated if the patient cannot exercise.

Question 2

Your patient is a 24-year-old female presenting with a "sore throat" and malaise for one week. On physical exam, you note posterior cervical lymphadenopathy and an enlarged spleen. Rapid strep test is negative. What is the most appropriate next step in diagnosis?

A. Throat Culture
B. Monospot (Heterophile Antibody) Test
C. CT Abdomen
D. Lateral Neck X-ray
E. CBC with Differential

Correct Answer: B. Monospot (Heterophile Antibody) Test
Explanation: The clinical presentation of posterior cervical lymphadenopathy and splenomegaly is highly suggestive of Infectious Mononucleosis. The Monospot test is the appropriate next step. Throat Culture (A) is redundant if the concern is viral mononucleosis. CT Abdomen (C) is not indicated for initial diagnosis, though it may visualize splenomegaly. Lateral Neck X-ray (D) is used for suspected epiglottitis, which presents with acute airway distress. CBC with Differential (E) may show atypical lymphocytosis but is less specific than the heterophile antibody test.

Question 3

Your patient is a 55-year-old male with a history of COPD presenting with increased cough and purulent sputum production. He is afebrile with a RR of 20 and SaO2 of 91% on room air. Chest X-ray shows no acute infiltrates. What is the first-line antibiotic treatment for this acute exacerbation of chronic bronchitis?

A. Vancomycin
B. Azithromycin
C. Ciprofloxacin
D. Metronidazole
E. Amoxicillin-clavulanate

Correct Answer: E. Amoxicillin-clavulanate
Explanation: In patients with COPD exacerbation and increased sputum purulence, Amoxicillin-clavulanate is a first-line choice to cover common pathogens like H. influenzae and M. catarrhalis. Vancomycin (A) is for MRSA and is not appropriate here. Azithromycin (B) is often used but has increasing resistance. Ciprofloxacin (C) is a fluoroquinolone typically reserved for suspected Pseudomonas. Metronidazole (D) covers anaerobes and is not indicated for standard COPD exacerbation.

Question 4

Your patient is a 42-year-old female complaining of a "burning" sensation in her chest that is worse after eating spicy foods and when lying down at night. She has tried OTC antacids with minimal relief. What is the most appropriate initial management step?

A. Upper Endoscopy (EGD)
B. Lifestyle modifications and H2-receptor antagonist
C. Referral to General Surgery
D. 24-hour pH monitoring
E. H. pylori stool antigen test

Correct Answer: B. Lifestyle modifications and H2-receptor antagonist
Explanation: For uncomplicated Gastroesophageal Reflux Disease (GERD) without "alarm symptoms" (dysphagia, weight loss, anemia), the initial step is lifestyle modifications and H2-receptor antagonists or PPIs. Upper Endoscopy (A) is reserved for patients over 50 or those with alarm symptoms. Referral to General Surgery (C) is only for refractory cases requiring fundoplication. 24-hour pH monitoring (D) is the gold standard but is not the initial step. H. pylori testing (E) is more relevant for suspected peptic ulcer disease rather than classic GERD.

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About the Author

Jeremy Boroff PA-C is a veteran healthcare provider with over 30 years of experience in the medical field. Having served as a Physician Assistant for over 24 years and a Registered Respiratory Therapist for 7 years, Jeremy has a profound understanding of clinical education. He has spent over two decades in the Emergency Department at St. Rita’s Medical Center and is the CEO of CME Review Courses. His mission is to provide PAs and PA students with the high-yield tools they need to succeed in their careers.

Secure your copy today and master the Family Medicine EOR:
Buy on Amazon: Family Medicine End of Rotation Review